PCOS, PCOD and Fertility

What PCOS and PCOD are

Polycystic ovary syndrome is one of the most common hormonal conditions in women of reproductive age. In PCOS, the ovaries contain a larger than usual number of small follicles, hormone levels are altered, and ovulation becomes irregular or stops.

“PCOD” — polycystic ovarian disease — is an older term still widely used in India, and in everyday practice the two are used interchangeably. PCOS is the term used in current medical literature, because the condition involves a cluster of features across the whole body rather than a disease of the ovary alone.

The name has been debated internationally, and a change has been proposed to better reflect its metabolic and hormonal nature. → LINK: [your PCOS/PMOS article]

The practical point for anyone reading this: if you have been told you have PCOD and someone else says PCOS, you have not been given two different diagnoses.

How PCOS affects fertility

The central issue is ovulation.

In a typical cycle, one follicle matures and releases an egg. In PCOS, hormonal imbalance interrupts this. Follicles begin to develop but frequently do not mature or release. Ovulation becomes unpredictable, infrequent, or stops altogether.

This has two consequences. Conception is less likely because eggs are released rarely or not at all. And it becomes hard to time intercourse, because without a predictable cycle there is no reliable fertile window to aim for.

It is worth being clear about what PCOS does not mean. It does not mean your ovaries have run out of eggs — women with PCOS often have a higher ovarian reserve than average. It does not mean you cannot conceive naturally. And it does not mean you will need IVF.

Signs and symptoms

PCOS presents differently in different women, and not everyone has every feature:

• Irregular, infrequent or absent periods
• Difficulty conceiving
• Excess hair growth on the face, chest or abdomen
• Acne, particularly along the jawline
• Weight gain, or difficulty losing weight
• Thinning hair on the scalp
• Darkened skin patches at the neck or in skin folds

Some women have marked symptoms with mild ovulatory disruption; others have few outward signs but do not ovulate. Symptom severity is not a reliable guide to fertility impact.

How PCOS is diagnosed

Diagnosis requires two of the following three, with other causes excluded:

Irregular or absent ovulation

Assessed from your cycle history — length, regularity, and whether periods occur at all.

Ultrasound findings

Transvaginal ultrasound assesses the number of small follicles and ovarian volume. Note that “polycystic-appearing ovaries” on a scan is a common finding and does not by itself confirm PCOS. Many women have this appearance with entirely normal cycles.

Ultrasound assessment at our centre is carried out by Dr. Pallavi Mane, whose areas of special interest include sonology. → LINK: /treatment-diagnostic/

Blood tests

Hormone levels including LH, FSH, testosterone, AMH, thyroid function and prolactin — the last two because thyroid disorders and raised prolactin can mimic PCOS and are treated quite differently. Blood glucose and insulin are often checked, as insulin resistance is common in PCOS.

Treatment pathway

Treatment is stepped. Most women start at the first step, and many never need the later ones.

Step 1 — Weight, insulin and lifestyle

For women who are overweight, this is the most effective single intervention. A modest reduction in body weight — often around 5 to 10% — can restore ovulation in a significant proportion of women with PCOS, without any other treatment.

That is not a small claim, and it is not a way of avoiding treatment. It is genuinely the intervention with the strongest evidence behind it, and it works because PCOS is closely linked to insulin resistance.

Where insulin resistance is present, medication to improve insulin sensitivity may be used alongside lifestyle measures.

Step 2 — Ovulation induction

Where ovulation does not return, oral medication is used to stimulate the ovary to mature and release an egg. Cycles are monitored by ultrasound to confirm response and to time intercourse. This is a low-cost, low-intervention treatment and it works for many women with PCOS.

Step 3 — IUI

Where ovulation induction alone has not worked, or where there is an additional factor such as mild male factor, prepared sperm is placed into the uterus at the time of ovulation. → LINK: /treatment-intrauterineinsemination/

Step 4 — IVF

Considered where earlier steps have not succeeded, or where another factor — tubal disease, significant male factor, age — makes it appropriate sooner. → LINK: /treatment-invitrofertilization/

Women with PCOS often respond strongly to ovarian stimulation, which means more eggs but also a higher risk of ovarian hyperstimulation syndrome. Protocols are adjusted accordingly, and this is one reason PCOS cycles benefit from careful monitoring.

Can you conceive naturally with PCOS?

Yes. Many women with PCOS conceive without any fertility treatment, some without ever having been diagnosed.

PCOS makes conception less predictable, not impossible. Where ovulation is restored — whether through weight management, treatment of insulin resistance, or medication — the chance of natural conception improves substantially.

We would rather tell you this plainly than move you toward the most expensive option available.

When to see a fertility specialist

• You have been trying to conceive for 12 months without success — or 6 months if you are over 35
• Your periods are absent or occur less than every 35 days
• You have been diagnosed with PCOS and are planning a pregnancy
• You have been on ovulation induction for several cycles without success

[CTA: Book a PCOS fertility assessment]

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Frequently asked questions

What is the difference between PCOS and PCOD?

In practice, none. PCOD is an older term still common in India; PCOS is the term used in current medical literature. They describe the same condition.

Can I get pregnant naturally with PCOS?

Many women do. PCOS makes ovulation irregular rather than absent in most cases, and restoring ovulation often restores natural fertility.

Does PCOS mean I will need IVF?

No. IVF is the fourth step in a stepped pathway, and most women with PCOS conceive before reaching it.

Does losing weight really improve fertility in PCOS?

Yes — for women who are overweight, this has stronger evidence behind it than any other single intervention. A reduction of 5 to 10% of body weight can restore ovulation.

Which tests confirm PCOS?

Cycle history, ultrasound, and blood tests for hormones, thyroid and prolactin. Diagnosis requires two of three criteria and exclusion of other causes.

Does PCOS increase the risk of miscarriage?

PCOS is associated with a somewhat higher miscarriage risk, linked to insulin resistance and weight. Managing these before conception is part of treatment.

Will PCOS affect my pregnancy?

It is associated with a higher chance of gestational diabetes and hypertension, so pregnancies are monitored more closely.

*Medically reviewed by [PLACEHOLDER — Dr. Pallavi Mane recommended for this page] · Last reviewed [Month Year]*